Meconium = stressed in utero, requiring intubation to clear airway

1.Turn equipment on and turn alarm off 2.Turn on lighting 3.“Turn on” temperature warmer 4.Turn on APGAR SCORE timer  1 and 5 minutes

APGAR SCORE – 5 pt assessment tool for 1 and 5 minute intervals (must 5 minute intervals until newborn reaches >7) 1.Appearance…by color (pink v. blue) 2.Pulse…by assessing HR or feeling the umbilical stalk (normal = >100) 3.Grimace…through touching (normal = screaming or crying) 4.Activity…through muscle tone (in which gestation plays a large role) 5.Respirations…by visualization of the chest or the monitor or by direct auscultation

Normal appearance (1-2 pts)

APGAR SCORE – Pulse (>100): Auscultate w/ stethoscope Brachial pulse (not on SIM baby) Umbilical stump (best) Refer to monitor for BPM

APGAR SCORE – Respirations: Auscultate B/L w/ stethoscope Listening for grunts Direct visualization of nasal flaring or belly breathing w/ retractions Refer to monitor for RR

1.Turn on APGAR SCORE timer when the baby arrives on the SIM table 2.Questions to ask: Is this newborn to term? Is the child breathing? Does the baby have good tone? 3.One person listens to HR and respirations while another dries and stimulates the baby If not crying, rub the back or tap the bottom of the feet 4.Tilt the head back and suction fluid out of the mouth and nose 5.Listen to the HR on the chest and feel the pulse through the umbilical stump 6.Listen to respirations and observe for signs of distress

Poor respiration or HR? Within 30 s, intervene w/ positive pressure: 1.While standing at the table, tilt the newborn’s head back 2.Place the mask over the nose (using the C-E technique to create a good seal around the mouth Do not accidentally obstruct the carotid a. with your fingers while placing the mask 3.Attach the bag mask and continue bagging with the head tilting, ensuring good entry and symmetric chest rise

Methods: Two-finger method (1 cm below the nipple line) Two-thumb method (w/ hands cradled around the sternum and ribs) Requires another person to bag

1.Undress the child entirely w/ the diaper on (to visually inspect baseline from head to toe) Size on fontanelle Palpate sutures Nasal bridge w/ symmetric breathing + Atresia w/ respiratory distress Epicranial folds Pits or tags near the ear (and palpate kidneys) Symmetric red reflex of eyes Cleft lip or palate of the mouth Presence of natal teeth Symmetric SCM m. Palpate clavicle and sternum Symmetric nipples Presence of 3 vessels at the umbilical cord (w/ max 2-3 cm) Palpate abdomen for masses/lesions while looking for infection Brachial and femoral pulses Check palmar aspect of the feet and hands Presence of abnormal rashes 2.Inspect and auscultate heart, lungs, and abdomen 3.Remove diaper and check for ambiguous genitalia (w/ symmetry and appropriate size/ dissension) 4.Check the hips (for dysplasia) through the Ortolani and Barlow methods Barlow method – application of downward pressure on 90° flexed hip (w/ longest finger at the posterior aspect of the femur)  Dislocation of the femur from the acetabulum Ortolani method – aBduction of the leg, causing the femur to relocate into the acetabulum (positive = “click” or “clunk”) 5.Neuro evaluation: Grasp reflex of the hands Moro reflex – grab the hands and let go to make the newborn appear startled Suck reflex Symmetric movement of the hands and feet Muscles symmetry Evaluation of spine for dimple, mass, or hair tuft